New Zealand’s longest covid-19 hospitalisation in Auckland and Northland during the first three months of the current outbreak was 61 days, and an overwhelming majority of patients were Māori or Pacific.

Figures from the Northern Region Health Coordination Centre (NRHCC) released to RNZ News under the Official Information Act (OIA) show 704 people with covid-19 were admitted to hospital between August 17 and November 18, 2021.

“There were 309 Māori patients, 295 Pacific patients, 36 Asian and the rest [64] were of other ethnicities,” Counties Manukau District Health Board chief executive Margie Apa said in the OIA response.

Responding to questions about the response in a statement, a Ministry of Health spokesperson said “protecting Māori and Pacific wellbeing has been an integral part of the ongoing covid-19 response”.

They said the ministry recognised the vulnerability of these communities, “especially given larger family sizes and complex health needs”.

They highlighted how the ministry had redirected $36 million to each of the Māori and Pacific health responses in this current outbreak.

“In addition to providing funding, we remain committed to working with a range of experts, providers, and partners to ensure our response continues to protect Māori and Pacific communities and keeps them safe from covid-19,” the spokesperson said.

‘Unfortunate but predictable’
National Māori Pandemic Group co-leader Dr Sue Crengle said the proportion of Māori and Pacific in the figures was unfortunate but “predictable, given what we know … about how Māori and Pacific communities and whānau are likely to be more vulnerable to transmission of the virus, and also more vulnerable to more severe outcomes”.

She said officials could have learnt and acted faster given the pandemic had been going for more than a year when this outbreak started. But she did note: “we haven’t had a pandemic on this scale since 1918”.

Crengle said there should have been “forward thinking” earlier on.

Apa said there were a total of 870 “patient events” – the difference between this number and the total patient count was because of things like patient transfers between hospitals.

The vast majority — 513 — were unvaccinated, with 124 people having had one jab, and 67 were fully vaccinated.

More than half of admissions (479) were for up to two days, compared with only 73 hospitalisations of 10 days or more.

However, 50 patients ended up in intensive care, seven of them being placed on a ventilator, and on 16 occasions people spent 10 days or more there – including two people who spent 950 hours there, which equated to almost 40 days.

Church deacon
One of those two patients would have been a 50-year-old man, who was a deacon at the Assemblies of God Church of Sāmoa and died in Middlemore Hospital in October.

A caveat of the data in this story was that some people had not been discharged by November 18 – the limit of the OIA request scope.

NHRCC forecasting of “specific hospitalisation predictions” only happened first on October 8, 2021 — more than two-and-a-half months into the outbreak — with the earliest predictions beginning November 9, 2021.

In a graph provided separately by the NHRCC communications team, there were at least three days where intensive care admissions met or were higher-than predicted between November 9 and December 10.

Overall hospitalisations in the same period were always below what NHRCC predicted. NHRCC predicted there would be just under 40 people in hospital in its catchment by 28 December.

Its “specific hospitalisation predictions” did not include modelling on the use of ventilators.

“The use of ventilators is a clinical decision made in response to a patient’s condition and while there are thresholds for use and pathways of care we have not modelled the expected use,” NHRCC said.

More hospitalisations
In contrast to NHRCC, Te Pūnaha Matatini researcher and covid-19 modeller Professor Michael Plank said there had been more hospitalisations than originally expected.

He thought that was likely down to the fact people were being hospitalised “for a shorter stay” so “they have a relatively small impact on the number of beds”.

Dr Plank said intensive care admissions were hard to predict and “to be honest, we haven’t spent a lot of time trying to model that”.

RNZ is awaiting national figures which have been requested from Ministry of Health.

An OIA request to the ministry for national figures was transferred to the NRHCC, a collective of the Northland and Auckland District Health Boards working together on the covid-19 response. National figures have been asked for again.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

On Tuesday (16 Nov) I was concerned to hear this story on RNZ’s Checkpoint (National distances itself from ex-MP after video with discredited academic). My concern here is not particularly with the “discredited academic”, although no academic should suffer this kind of casual public slur. (Should we go further and call Simon Thornley, the academic slurred, a ‘trailing epidemiologist’? In contrast to the epithet ‘leading epidemiologist’, as applied to Rod Jackson in this story from Newshub.) Academics should parley through argument, not insult.

As well as with RNZ, my concern is with Rod Jackson, who not only made an ad hominem attack on an academic colleague, but made an insensitive remark which, in some circles, would count as ‘casual racism’. Casual ‘institutional racism’ is often cited as a reason why, for example, Māori and Pasifika appear to underachieve in a range of national statistical indicators; and, for the most part, such institutional racism is understood to be unintended. (An example I heard mentioned recently is the under-referral of Māori by general practitioners to specialists. In my view, this evidential discrimination happens mainly because Pakeha are more likely than Māori to have medical insurance; and people with medical insurance are more likely to be referred to specialists. So I am not convinced that this example is a valid indicator of institutional racism within the Health sector.)

The problem is this sentence from the RNZ synopsis: “Professor Jackson also said it [sic] claiming Covid-19 was no worse than the flu was nonsense”, which, as well as being part of Jackson’s attack on Thornley, was an insensitive dismissal of Pasifika and Māori experiences of influenza. In 1918/19, an estimated 22 percent of Samoa’s population had died from the novel H1N1 influenza; many bodies turning black, before death, from advanced pneumonia. The ‘Black Flu’ arrived in Apia from Auckland on board the SS Talune, with infected passengers being allowed to disembark. The ship had previously quarantined in Fiji. The result was “one of the most disastrous epidemics recorded anywhere in the world during the present century, so far as the proportion of deaths to the population is concerned” (NZ History).

A more aware epidemiologist than Rod Jackson would have realised that, in these last few weeks, Māori continue to relate to the 1918 influenza pandemic; refer, for example, Concerns raised around how to enforce exclusion of unvaccinated from tangihanga, 24 Oct 2021.

The historiography of epidemics in Aotearoa New Zealand is very sketchy. It is appropriate here to outline the main events over the past 125 years, noting that many Pakeha and especially Māori died from epidemic diseases before 1886. (Refer A timeline of epidemics in New Zealand, 1817–2020, Te Ara)

1886 is a good year to start a timeline of recent ‘influenza’ pandemics; it was a census year, and it was the year of the Mt Tarawera eruption. (In 1886, 120 people, ‘mostly Māori’, died as a result of the Mt Tarawera eruption; 0.25% of all Māori died in one event, comparable with the present official mortality rate in the USA from Covid19.) As this chart from Te Ara shows, Māori population in 1840 was about 80,000; and that’s after the Musket Wars which had already had a huge demographic impact on Māori. 250 years ago, the New Zealand population – all Māori – was almost certainly over 100,000. In 1886 the Māori population was estimated to be 44,000. Ten years later, in 1896, it was estimated at 42,000; its historical nadir.

Influenza and Coronavirus pandemics in New Zealand’s History

Russian Flu

‘Influenza’ (in the title to this essay) means influenza or coronavirus, given that likely past coronavirus events have been documented as influenza (indeed possibly going back to the time of Queen Elizabeth 1). From 1890 to 1894, indications are that upto 2,000 Māori died from what at the time was called the ‘Russian Flu’. That’s 4.0% to 4.5% of the surviving Māori population.

The Russian Flu pandemic has been one of the biggest unsung mysteries in epidemiological history. However the view is firming that this was Covid1889 (Coronavirus OC43). (Alternatively, it could have been A/H3N8 or A/H2N2 influenza.) Wikipedia, citing a Danish article, says “the 1889–1890 pandemic produced symptoms closer to those associated with COVID-19 (the infection caused by the SARS-CoV2 betacoronavirus) than to Influenza”.

In New Zealand this ‘flu’ circulated from 1890 to 1894, and 1,393 deaths were attributed to it, based on death certificates. This documented toll largely excludes Māori, and by no means includes all Pakeha who died from this pandemic. We also know that the Māori population took its last big hit in the period from 1891 to 1895. Whether covid or influenza, this pandemic was a big deal in New Zealand; a mass death event that fell under the historiographic radar.

Black Flu (aka Spanish Flu)

Could epidemiologists – and politicians and bureaucrats – please refrain from making statements to the effect that Covid19 has been worse (or ‘much worse’) than influenza?

The 1918 influenza pandemic’s lethal second wave took 4.2% to 4.3% of Māori lives (‘small’ when compared to Samoan lives!). For Māori, it appears to be very much on a par with the previous ‘Russian Flu’ pandemic, albeit in a more compressed time scale. The cost in lives for ‘all ethnicities’ in New Zealand was about 9,000; that’s a 0.7% toll. While this pandemic was misleadingly called Spanish Flu (Spain was a non-combatant in World War 1, and therefore was better placed to document it), it is best called the ‘Black Flu’, because many of the victims turned a black colour reminiscent of pneumonic plague. (At the time, bubonic plague was very much on epidemiologists’ radars, in New Zealand and elsewhere, with recurrent outbreaks in California.)

This lethal novel H1N1 influenza strain was possibly the result of a hybridisation of two separate influenzas circulating on the western front of World War One; one variant of American origin, and one of Chinese origin. The first wave of influenza in 1918, which hit New Zealand around August of 1918, was nasty but not lethal. It appears to have given immunity to those who caught it, which is one reason why an unusually large number of younger people died, in November in New Zealand, from the lethal second wave. (It’s also a reason why it’s hard to trace the progress of the virus through New Zealand; while death data is quite good, infection data is at best anecdotal.)

For information on the Black Flu in New Zealand, the standard reference is Geoffrey Rice’s Black November (especially the 2005 second edition, available as an e-book). For the global picture, a particularly accessible book is Laura Spinney’s The Pale Rider (2017). For a shorter account of that influenza pandemic, topped-up by accounts of subsequent global epidemics (including SARS 2003), see Mark Honigsbaum’s 2019 book The Pandemic Century.

Influenza Pandemics from 1957

Surprisingly, Te Ara’s Timeline of epidemics in New Zealand, 1817–2020, fails to even mention the 1957 and 1968/69 influenza pandemics as New Zealand events. However, Michael Baker et.al.estimated the New Zealand toll as being 0.0064%, with high a rate of 0.04% for Māori. This overall toll is comparable with Australia’s current toll for Covid19.

For 1968/69, the figure.nz chart shows how New Zealand influenza mortality relates to more recent flu seasons. While annual flu deaths were very high for that pandemic (0.05% of New Zealand’s then population, for three consecutive years) they were routinely at similar levels in the 1980s, with a sudden dive in 1997 when funded influenza vaccines became available in New Zealand.

The 2009 H1N1 ‘Swine Flu’ pandemic was a non-event in New Zealand. But, as noted in a previous essay, the 2017 influenza season was particularly bad (0.02% of New Zealanders died of it), and was a pandemic in all senses except for WHO’s designation. In Europe, some countries had higher mortality tolls from the 2017-18 flu winter than from Covid19 in 2020.

Coronavirus

Covid – whether in 1890 or 2020 – most likely affected tropical countries more than these influenzas in temperate lands. But the big novel-strain influenza pandemics also dramatically affect unprepared tropical populations, such as Samoa in 1918.

Covid19 may well be unusually problematic – as was the 1918 influenza – because it may have been a hybrid rather than a mutation. “If a bat infected with one coronavirus catches a second one, the two different viruses may end up in a single cell at once. As that cell begins to replicate each of those viruses, their genes get shuffled together, producing new virus hybrids.” (Refer New York Times Newly discovered bat viruses give hint’s to Covid’s origins, 14 October 2021.) We also note that SARS-Cov1 (Covid02?) was a more lethal virus than Covid19’s SARS-Cov2, though less transmissible; Covid19 may have hit the sweet spot – from the virus’s viewpoint – of getting the optimal balance between transmissibility and lethality.

(It should be noted that a really significant development of the theory of evolution is the development of hybrid species. I first encountered this when reading Tim Flannery’s 2018 bookEurope. Then recently, I read Alice Roberts’ excellent 2017 book Tamed, which looks at hybridisation and species’ domestication. Indeed, humans are a hybrid species, and domestication is a mutual process. An interesting insight is the potential to apply these insights to microevolution, and to think of the present OC43 coronavirus as a domesticate of the original wild virus, and to think likewise of an immune urban human population as a species adaptation.)

Overall, which disease is worse – Covid or Influenza? The only sensible answer is that it is a tie. Neither disease should be downplayed. Both can be lethal in unprepared populations. Please do not trivialise influenza.

Selected References (excludes some media stories already linked to):

Māori and European population numbers, 1838–1901, NZ History (Te Ara version)

A timeline of epidemics in New Zealand, 1817–2020, Te Ara

Clinical evidence that the pandemic from 1889 to 1891 commonly called the Russian flu might have been an earlier coronavirus pandemic, Harald Brüssow and Lutz Brüssow, Microbial Biotechnology, 13 July 2021

Death by Numbers, New Zealand Mortality Rates in the 1918 Influenza Pandemic, 2006 Fifth Year Medical students: Group E Public Health Project, Otago University [Ministry of Health website]

Relatively High Mortality for Māori and Pacific Peoples in the 2009 Influenza Pandemic and Comparisons with Previous Pandemics,
Nick Wilson, Lucy Barnard, Jennifer Summers, Dennis Shanks, Michael Baker [Otago University website]

Deaths caused by influenza and pneumonia in New Zealand, chart by figure.nz, using Ministry of Health data

The history of immunisation in New Zealand, Ministry of Health website

Newly discovered bat viruses give hint’s to Covid’s origins, New York Times, 14 October 2021 (NZ Herald 15 Oct)

The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris, 2019, by Mark Honigsbaum

Black November: The 1918 influenza pandemic in New Zealand, second edition 2005, by Geoffrey Rice

Pale Rider: The Spanish Flu of 1918 and How It Changed the World, 2017, Laura Spinney

Tamed, 2017, by Alice Roberts

Europe, 2018, by Tim Flannery

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Auckland’s move to alert level 3 has also triggered speculation about whether the national covid-19 elimination strategy has failed or is even being abandoned. While the New Zealand government denies it, others clearly believe it is at least a possibility.

The uncertainty is troubling. If elimination fails or is abandoned, it would suggest we have not learnt the lessons of history, particularly when it comes to our more vulnerable populations.

In 1918, the mortality rate among Māori from the influenza pandemic was eight times that of Europeans. The avoidable introduction of influenza to Samoa from Aotearoa resulted in the deaths of about 22 percent of the population.

Similar observations were seen in subsequent influenza outbreaks in Aotearoa in 1957 and 2009 for both Māori and Pasifika people. These trends are well known and documented.

And yet, despite concerns we could see the same thing happen again, there have been repeated claims that an elimination strategy cannot succeed. Some business owners, politicians and media commentators have called for a change in approach that would see Aotearoa “learn to live with the virus”.

This is premature and likely to expose vulnerable members of our communities to the disease. Abandoning the elimination strategy while vaccine coverage rates remain low among the most vulnerable people would be reckless and irresponsible.

In short, more Māori and Pasifika people would die.

Far better will be to stick to the original plan that has served the country well, lift vaccination coverage rates with more urgency, and revise the strategy when vaccination rates among Māori and Pasifika people are as high as possible — no less than 90 percent.

Least worst options
After 18 months of dealing with the pandemic, it’s important to remember that Aotearoa’s response has been based on sound science and strong political leadership. The elimination strategy has proved effective at home and been admired internationally.

Of course, it has come with a price. In particular, the restrictions have had a major impact on small businesses and personal incomes, student life and learning, and well-being in general.

Many families have needed additional food parcels and social support, and there are reports of an increasing incidence of family harm.

The latest delta outbreak has also seen the longest level 4 lockdown in Auckland, with at least two further weeks at level 3, and there is no doubt many people are struggling to cope with the restrictions. The “long tail” of infections will test everyone further.

There is no easy way to protect the most vulnerable people from the life-threatening risk of covid-19, and the likely impact on the public health system if it were to get out of control. The alternative, however, is worse.

We know Māori and Pasifika people are most at risk of infection from covid-19, of being hospitalised and of dying from the disease.

Various studies have confirmed this, but we also must acknowledge why — entrenched socioeconomic disadvantage, overcrowded housing and higher prevalence of underlying health conditions.

More than 50 percent of all new cases in the current outbreak are among Pasifika people and the number of new cases among Māori is increasing. If and when the pandemic is over, the implications of these socioeconomic factors must be part of any review of the pandemic strategy.

Lowest vaccination rates, highest risk
Furthermore, the national vaccination rollout has again shown up the chronic entrenched inequities in the health system. While the rollout is finally gaining momentum, with more and better options offered by and for Māori and Pasifika people, their comparative vaccination rates have lagged significantly.

Community leaders and health professionals have long called for Māori and Pasifika vaccination to be prioritised. But the official rhetoric has not been matched by the reality, as evidenced by our most at-risk communities still having the lowest vaccination coverage rates in the country.

Te Rōpū Whakakaupapa Urutā (the National Māori Pandemic Group) and the Pasifika Medical Association have repeatedly called for their communities to be empowered and resourced to own, lead and deliver vaccination rollouts in ways that work for their communities.

Te Rōpū Whakakaupapa Urutā have also said Auckland should have remained at level 4, with the border extended to include the areas of concern in the Waikato.

As has been pointed out by those closest to those communities, however, their advice has consistently not been heeded. The resulting delays only risk increasing the need for the kinds of lockdowns and restrictions everyone must endure until vaccination rates are higher.

There is a reason we do not hear many voices in Māori and Pasifika communities asking for an end to elimination. Left unchecked, covid-19 disproportionately affects minority communities and the most vulnerable.

“Living with the virus” effectively means some people dying with it. We know who many of them would be.

Dr Collin Tukuitonga is associate dean Pacific and associate professor of public health, University of Auckland. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz